1467406181 NPI number — DAKOTA CLINIC, LTD.

Table of content: (NPI 1467406181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467406181 NPI number — DAKOTA CLINIC, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA CLINIC, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467406181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 3RD ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58401-4247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-253-5300
Provider Business Mailing Address Fax Number:
701-253-5402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WATER STREET E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-486-3550
Provider Business Practice Location Address Fax Number:
701-486-3496
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLBERG
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ADMINISTRATOR-AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
701-364-3405

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10894 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com